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Splenic laceration:

Splenic laceration Most common injury in blunt abdominal trauma and with penetrating wounds of left lower thorax and upper abdomen Routine splenectomy rare Splenorrhaphy (repairing the spleen) more common Decreases incidence of sepsis Can take to angiography to embolize lac

Liver laceration:

Liver laceration Second most common injury associated with abdominal trauma Exsanguniating hemorrhage can occur Majority of liver injuries (85-90%) heal spontaneously and may only require surgical drainage

Pelvic fractures:

Pelvic fractures Result in major hemorrhage 25% of time Exsanguination 1% of time Bleeding results from disruption of veins from bone fragments Emergent or elective external fixation can be followed by angiography Arterial bleeding can be embolized Bladder injuries often associated with pelvic fracture Urethrogram should be performed before foley inserted

Abdominal and pelvic trauma:

Abdominal and pelvic trauma Anesthetic concerns revolve around hemorrhage, hypothermia, sepsis/peritonitis and impairment of ventilation Warming measure are crucial since large heat loss from open mesentery and shock Avoid N20 to prevent bowel distention Fluid resuscitation imperative The pelvis can hold up to 3 liters

Extremity trauma:

Extremity trauma Usually not immediately life-threatening and part of secondary survey Can be associated with vascular injuries causing hemorrhage, shock, sepsis, fat emboli, and thromboembolic hypoxic respiratory failure

Open fractures:

Open fractures Ideal to repair in first few hours post injury so full stomach precautions Should repair within 6 hours to lessen incidence of sepsis If obvious hemorrhage, hold pressure manually; can have MAST pants applied while in field

Head injury: Leading cause of death from trauma:

Head injury: Leading cause of death from trauma Goal is prevention of secondary brain damage resulting from intracranial bleeding, increased ICP, edema TBI: Traumatic Brain Injury ICI: Intracranial Injury Management should include early control of airway, cardiovascular stability, and avoidance of increased ICP Patients with suspected head injury should be placed head up position to promote venous drainage and decrease ICP; moderate hyperventilation to 30 mmHg